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Iraha Y, Fujii S, Tsuchiya N, Azama K, Yonamine E, Mekaru K, Kinjo T, Sekine M, Nishie A. Diffusion lacunae: a novel MR imaging finding on diffusion-weighted imaging for diagnosing placenta accreta spectrum. Jpn J Radiol 2024:10.1007/s11604-024-01657-6. [PMID: 39259419 DOI: 10.1007/s11604-024-01657-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To evaluate the usefulness of novel diffusion-weighted imaging (DWI) findings for diagnosing placenta accreta spectrum (PAS). MATERIALS AND METHODS This retrospective study included 49 pregnant women with suspected PAS who underwent 1.5 T placental MRI. Diffusion lacunae were defined as intraplacental areas showing hypointensity on DWI and hyperintensity on the apparent diffusion coefficient map. Two radiologists evaluated the number and size of placental lacunae on DWI, and flow void in the diffusion lacunae on T2-weighted imaging. The radiologists also evaluated established MRI features of PAS described in the SAR-ESUR consensus statement. Pearson's chi-square test or Mann-Whitney U test was used to compare findings between patients with and without PAS. Interobserver reliability for DWI and established MRI features was also assessed. Optimal thresholds for the number and maximum size of diffusion lacunae for differentiating PAS from the no-PAS group were determined using receiver operating characteristic curve analyses. RESULTS Eighteen patients were diagnosed with PAS, and 31 patients with placental previa without PAS. The number and maximum size of diffusion lacunae were significantly larger in patients with than in patients without PAS (p < 0.0001). Combining assessment of the number of diffusion lacunae with assessment of their maximum size yielded a diagnostic performance with sensitivity, specificity and accuracy of 83%, 94% and 90%, respectively. Flow voids within the diffusion lacunae had sensitivity, specificity and accuracy of 88%, 84% and 86%, respectively. CONCLUSION The number and size of diffusion lacunae, and T2 flow void in diffusion lacunae may be useful findings for diagnosing PAS.
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Affiliation(s)
- Yuko Iraha
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan.
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1, Nishi-Cho, Yonago, Tottori, Japan
| | - Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Kimei Azama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Eri Yonamine
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Keiko Mekaru
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Tadatsugu Kinjo
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
| | - Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan
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Araujo Júnior E, Caldas JVJ, Sun SY, Castro PT, Passos JP, Werner H. Placenta acrreta spectrum-first trimester, 2D and 3D ultrasound, and magnetic resonance imaging findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:321-330. [PMID: 38126224 DOI: 10.1002/jcu.23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The term placenta accreta spectrum (PAS) is commonly used to describe abnormal trophoblastic invasion of the myometrium, serosa, or organs adjacent to the uterus. It is of great obstetric importance because of its high morbidity, risk of hemorrhage, admission to the intensive care unit, risk of hysterectomy, and high risk of iatrogenic pelvic lesions and even death. These risks are minimized when prenatal diagnosis is performed. Prenatal diagnosis of PAS is based on imaging findings suggestive of abnormal and pathologically adherent placentation, including placental lacunae (intraplacental sonolucent spaces), disruption of the bladder-uterine serosa interface, turbulent flow on color Doppler, and bridging vessels. OBJECTIVE In this article, we review the major prenatal imaging features of PAS using diagnostic modalities (first trimester, two-dimensional ultrasound, three-dimensional ultrasound, and magnetic resonance imaging) for the diagnosis of PAS.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - João Victor Jacomele Caldas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Sue Yasaki Sun
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Pedro Teixeira Castro
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro-RJ, Brazil
| | - Jurandir Piassi Passos
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro-RJ, Brazil
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Liu Q, Zhou W, Yan Z, Li D, Lou T, Yuan Y, Rong P, Feng Z. Development and validation of MRI-based scoring models for predicting placental invasiveness in high-risk women for placenta accreta spectrum. Eur Radiol 2024; 34:957-969. [PMID: 37589907 DOI: 10.1007/s00330-023-10058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To develop and validate MRI-based scoring models for predicting placenta accreta spectrum (PAS) invasiveness. MATERIALS AND METHODS This retrospective study comprised a derivation cohort and a validation cohort. The derivation cohort came from a systematic review of published studies evaluating the diagnostic performance of MRI signs for PAS and/or placenta percreta in high-risk women. The significant signs were identified and used to develop prediction models for PAS and placenta percreta. Between 2016 and 2021, consecutive high-risk pregnant women for PAS who underwent placental MRI constituted the validation cohort. Two radiologists independently evaluated the MRI signs. The reference standard was intraoperative and pathologic findings. The predictive ability of MRI-based models was evaluated using the area under the curve (AUC). RESULTS The derivation cohort included 26 studies involving 2568 women and the validation cohort consisted of 294 women with PAS diagnosed in 258 women (88%). Quantitative meta-analysis revealed that T2-dark bands, placental/uterine bulge, loss of T2 hypointense interface, bladder wall interruption, placental heterogeneity, and abnormal intraplacental vascularity were associated with both PAS and placenta percreta, and myometrial thinning and focal exophytic mass were exclusively associated with PAS. The PAS model was validated with an AUC of 0.90 (95% CI: 0.86, 0.93) for predicting PAS and 0.85 (95% CI: 0.79, 0.90) for adverse peripartum outcome; the placenta percreta model showed an AUC of 0.92 (95% CI: 0.86, 0.98) for predicting placenta percreta. CONCLUSION MRI-based scoring models established based on quantitative meta-analysis can accurately predict PAS, placenta percreta, and adverse peripartum outcome. CLINICAL RELEVANCE STATEMENT These proposed MRI-based scoring models could help accurately predict PAS invasiveness and provide evidence-based risk stratification in the management of high-risk pregnant women for PAS. KEY POINTS • Accurately identifying placenta accreta spectrum (PAS) and assessing its invasiveness depending solely on individual MRI signs remained challenging. • MRI-based scoring models, established through quantitative meta-analysis of multiple MRI signs, offered the potential to predict PAS invasiveness in high-risk pregnant women. • These MRI-based models allowed for evidence-based risk stratification in the management of pregnancies suspected of having PAS.
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Affiliation(s)
- Qianyun Liu
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Wenming Zhou
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Zhimin Yan
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Da Li
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Tuo Lou
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yishu Yuan
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Pengfei Rong
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhichao Feng
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China.
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Moradi B, Azadbakht J, Sarmadi S, Gity M, Shirali E, Azadbakht M. Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review. RADIOLOGIA 2023; 65:531-545. [PMID: 38049252 DOI: 10.1016/j.rxeng.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/11/2023] [Indexed: 12/06/2023]
Abstract
Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis and treatment. Pathological examination or imaging evaluation are not very dependable when considered as stand-alone diagnostic tools. On the other hand, timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patient goes through the third phase of delivery in a not well-suited facility. A multidisciplinary approach for diagnosis (incorporating clinical, imaging, and pathological evaluation) is mandatory, particularly in complicated cases. For imaging evaluation, the diagnostic modality of choice in most scenarios is ultrasound (US) exam; patients are referred for MRI when US is equivocal, inconclusive, or not visualizing placenta properly. Herewith, we review the reported US and MRI features of PAS disorders (mainly focusing on MRI), going over the normal placental imaging and imaging pitfalls in each section, and lastly, covering the imaging findings of PAS disorders in the first trimester and cesarean section pregnancy (CSP).
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Affiliation(s)
- B Moradi
- Departamento de Radiología, Hospital General Yas, Universidad de Ciencias Médicas de Teherán, Teheran, Iran; Departamento de Radiología, Centro de Investigación de Diagnóstico Avanzado y Radiología Intervencionista (ADIR), Centro de Imagen Médica, Complejo Hospitalario Imán Jomeini, Universidad de Ciencias Médicas de Teherán, Teheran, Iran
| | - J Azadbakht
- Departamento de Radiología, Facultad de Medicina, Universidad de Ciencias Médicas de Kashan, Kashan, Iran.
| | - S Sarmadi
- Departamento de Patología, Hospital General Yas, Universidad de Ciencias Médicas de Teherán, Teheran, Iran
| | - M Gity
- Departamento de Radiología, Hospital General Yas, Universidad de Ciencias Médicas de Teherán, Teheran, Iran; Departamento de Radiología, Centro de Investigación de Diagnóstico Avanzado y Radiología Intervencionista (ADIR), Centro de Imagen Médica, Complejo Hospitalario Imán Jomeini, Universidad de Ciencias Médicas de Teherán, Teheran, Iran
| | - E Shirali
- Departamento de Oncología Ginecológica, Hospital General Yas, Universidad de Ciencias Médicas de Teherán, Teheran, Iran
| | - M Azadbakht
- Escuela de Farmacología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
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Lu T, Wu M, Wang Y, Li M, Li H, Zhang F, Yi Y, Zhu M, Zhao X. Association of MRI Features and Adverse Maternal Outcome in Patients With Placenta Accreta Spectrum Disorders After Abdominal Aortic Balloon Occlusion. J Magn Reson Imaging 2023; 58:817-826. [PMID: 36606736 DOI: 10.1002/jmri.28591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND MRI features may be associated with adverse maternal outcome in patients with placenta accreta spectrum (PAS) disorders even with abdominal aortic balloon occlusion (AABO). PURPOSE This study aimed to identify risk factors of MRI for association with adverse maternal outcome in patients with PAS disorders after AABO. STUDY TYPE Retrospective. POPULATION Clinical and MRI features of 80 patients were retrospectively reviewed from October 2016 to August 2021. A total of 40 patients had adverse maternal outcomes including intrapartum/peripartum bleeding >1000 mL and/or emergency hysterectomy after AABO. SEQUENCE Half-Fourier acquisition single-shot turbo spin echo and gradient echo imaging True fast imaging with steady-state precession (True-FISP) at 1.5T MR scanner. ASSESSMENT MRI features were evaluated by three radiologists and were tested for any association with adverse maternal outcome. STATISTICAL TESTS Interobserver agreement was calculated with kappa (k) statistics. Association between MRI features and adverse maternal outcomes were evaluated by univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. RESULTS The interobserver agreement ranged from fair to substantial (k = 0.379-0.783). Multivariate analyses revealed that short cervical length (OR: 4.344), abnormal intraplacental vascularity (OR: 6.005), placental bulge (OR: 9.085), and myometrial interruption (OR: 9.550) were independent risk factors for adverse maternal outcomes. The combination of four risk factors together demonstrated the highest AUC of 0.851 (95% CI 0.769-0.933) with a sensitivity and specificity of 77.5% and 72.5%, respectively and then a nomogram composed of the above four risk factors was constructed to represent the probability of adverse maternal outcome. DATA CONCLUSION The nomogram demonstrated the association between MRI features and patient's poor outcome after undergoing AABO and C-section delivery for PAS. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingpeng Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Yi
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Meilin Zhu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Mori N, Mugikura S. Letter to the editor: Radiomics features of patients with placenta accreta spectrum: A quantification of heterogeneity caused by intraplacental T2-hypointense bands. Int J Gynaecol Obstet 2023; 162:781-782. [PMID: 37349992 DOI: 10.1002/ijgo.14977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Shunji Mugikura
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Li H, Lu T, Li M, Wang Y, Zhang F, Yuan Y, Zhu M, Zhao X. Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging. Insights Imaging 2023; 14:93. [PMID: 37222836 DOI: 10.1186/s13244-023-01448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES To identify whether parameters measured from diffusion kurtosis and intravoxel incoherent motion help diagnose placenta percreta. METHODS We retrospectively enrolled 75 patients with PAS disorders including 13 patients with placenta percreta and 40 patients without PAS disorders. Each patients underwent diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC), perfusion fraction (f), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), mean diffusion kurtosis (MK) and mean diffusion coefficient (MD) were measured by the volumetric analysis and compared. MRI features were also analyzed and compared. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to evaluate the diagnostic efficiency of different diffusion parameters and MRI features for distinguishing placental percreta. RESULTS D* was an independent risk factor from DWI for predicting placenta percreta with sensitivity of 73% and specificity of 76%. Focal exophytic mass remained as independent risk factor from MRI features for predicting placenta percreta with sensitivity of 72.7% and specificity of 88.1%. When the two risk factors were combined together, the AUC was the highest, 0.880 (95% CI 0.8-0.96). CONCLUSION D* and focal exophytic mass were associated with placenta percreta. A combination of the 2 risk factors can be used to predict placenta percreta. CRITICAL RELEVANCE STATEMENT A combination of D* and focal exophytic mass can be used to differentiate placenta percreta.
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Affiliation(s)
- Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China.
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Feng Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yi Yuan
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Meilin Zhu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
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Ren H, Mori N, Mugikura S, Takase K. Letter to the editor on “The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders”. Placenta 2022; 128:72. [DOI: 10.1016/j.placenta.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022]
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Grading of placental accrete spectrum using texture analysis of magnetic resonance imaging. Clin Imaging 2022; 85:8-9. [DOI: 10.1016/j.clinimag.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
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Polizio RP, Yamauchi FI, Mendes RFP, Peres SV, Kondo MM, Francisco RPV. Magnetic resonance imaging and previous cesarean section in placenta accrete spectrum disorder: Predictor model. Clinics (Sao Paulo) 2022; 77:100027. [PMID: 35364517 PMCID: PMC8971588 DOI: 10.1016/j.clinsp.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate objective criteria of Magnetic Resonance Imaging (MRI) of Placenta Accreta Spectrum disorder (PAS) analyzing interobserver agreement and to derive a model including imaging and clinical variables to predict PAS. METHODS A retrospective review including patients submitted to MRI with suspicious findings of PAS on ultrasound. Exclusion criteria were lack of pathology or surgical information and missing or poor-quality MRI. Two radiologists analyzed six MRI features, and significant clinical data were also recorded. PAS confirmed on pathology or during intraoperative findings were considered positive for the primary outcome. Variables were tested through logistic regression models. RESULTS Final study included 96 patients with a mean age of 33 years and 73.0% of previous C-sections. All MRI features were significantly associated with PAS for both readers. After logistic regression fit, including MRI signs with a moderate or higher interobserver agreement, intraplacental T2 dark band was the most significant radiologic criteria, and ROC analysis resulted in an AUC = 0.782. After including the most relevant clinical data (previous C-section) to the model, the ROC analysis improved to an AUC = 0.893. CONCLUSION Simplified objective criteria on MRI, including intraplacental T2 dark band associated with clinical information of previous C-sections, had the highest accuracy and was used for a predictive model of PAS.
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Affiliation(s)
- Rodrigo Pamplona Polizio
- Departamento de Radiologia e Diagnóstico por Imagem do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Fernando Ide Yamauchi
- Departamento de Radiologia e Diagnóstico por Imagem do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Renata Franco Pimentel Mendes
- Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Stela Verzinhasse Peres
- Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mario Macoto Kondo
- Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Ren H, Mori N, Mugikura S, Shimizu H, Kageyama S, Saito M, Takase K. Prediction of placenta accreta spectrum using texture analysis on coronal and sagittal T2-weighted imaging. Abdom Radiol (NY) 2021; 46:5344-5352. [PMID: 34331104 DOI: 10.1007/s00261-021-03226-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE To separately perform visual and texture analyses of the axial, coronal, and sagittal planes of T2-weighted images and identify the optimal method for differentiating between the normal placenta and placenta accreta spectrum (PAS). METHODS Eighty consecutive patients (normal group, n = 50; PAS group, n = 30) underwent preoperative MRI. A scoring system (0-2) was used to evaluate the degree of abnormality observed in visual analysis (bulging, abnormal vascularity, T2 dark band, placental heterogeneity). The axial, coronal, and sagittal planes were manually segmented separately to obtain texture features, and seven combinations were obtained: axial; coronal; sagittal; axial and coronal; axial and sagittal; coronal and sagittal; and axial, coronal, and sagittal. Feature selection using the least absolute shrinkage and selection operator method and model construction using a support vector machine algorithm with k-fold cross-validation were performed. AUC was used to evaluate diagnostic performance. RESULTS The AUC of visual analysis was 0.75. The model 'coronal and sagittal' had the highest AUC (0.98) amongst the seven combinations. The fivefold cross-validation for the model 'coronal and sagittal' showed AUCs of 0.85 and 0.97 in training and validation sets, respectively. The AUC of the model 'coronal and sagittal' for all subjects was significantly higher than that of visual analysis (0.98 vs. 0.75; p < 0.0001). CONCLUSION The model 'coronal and sagittal' can accurately differentiate between the normal placenta and PAS, with a significantly better diagnostic performance than visual analysis. Texture analysis is an optimal method for differentiating between the normal placenta and PAS.
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Ren H, Mori N. Letter to "Development and validation of a magnetic resonance imaging-based nomogram for predicting invasive forms of placental accreta spectrum disorders". J Obstet Gynaecol Res 2021; 47:4502-4503. [PMID: 34494342 DOI: 10.1111/jog.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hainan Ren
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Review of MRI imaging for placenta accreta spectrum: Pathophysiologic insights, imaging signs, and recent developments. Placenta 2020; 104:31-39. [PMID: 33238233 DOI: 10.1016/j.placenta.2020.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/25/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
Placenta Accreta Spectrum (PAS) refers to the range of abnormally adhesive and penetrative placental tissue at a uterine scar. PAS is divided into accreta, increta, and percreta based on degree of myometrial invasion. Its incidence has increased, and PAS is now the leading indication for emergency peripartum hysterectomy in the setting of catastrophic hemorrhage from a non-separating placenta. The recent release of the International Federation of Gynecology and Obstetrics (FIGO) guidelines in 2018 coupled with the joint consensus statement from the Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) in 2020 reflect decades worth of diagnostic and therapeutic advances in this field. Although the increasing role of MRI in PAS diagnosis is evident, the literature on PAS reveals several disparate but conceptually overlapping MRI signs. Identifying and differentiating between placenta increta and percreta on imaging may be quite challenging even with MRI and sometimes even on final pathology. In this review, we aim to (i) provide a clarified understanding of PAS pathophysiology, (ii) comprehensively review and classify MRI signs based on pathophysiologic underpinnings, (iii) highlight shortcomings in the current PAS literature; and (iv) highlight best practice guidelines for imaging diagnosis of PAS.
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Agostini TCF, Figueiredo R, Warmbrand G, Torres US, Pria HRFD, D'Ippolito G. Placental adhesion disorder: magnetic resonance imaging features and a proposal for a structured report. Radiol Bras 2020; 53:329-336. [PMID: 33071377 PMCID: PMC7545732 DOI: 10.1590/0100-3984.2019.0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.
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Affiliation(s)
- Thais Coura Figueiredo Agostini
- Departamento de Diagnóstico por Imagem da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Reginaldo Figueiredo
- Departamento de Anatomia e Imagem da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | - Hanna Rafaela Ferreira Dalla Pria
- Departamento de Diagnóstico por Imagem da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Departamento de Diagnóstico por Imagem da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Poder L, Weinstein S, Maturen KE, Feldstein VA, Mackenzie DC, Oliver ER, Shipp TD, Strachowski LM, Sussman BL, Wang EY, Weber TM, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Placenta Accreta Spectrum Disorder. J Am Coll Radiol 2020; 17:S207-S214. [PMID: 32370965 DOI: 10.1016/j.jacr.2020.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Placenta accreta spectrum disorder (PASD) is the current terminology recommended by the International Federation of Obstetrics and Gynecology (FIGO) and should replace terms such as abnormally adherent/invasive placenta or morbidly adherent placenta. PASD refers to a variety of potential clinical complications, which may result from abnormal placental implantation. More specifically, placenta accreta refers to a defect in the decidua basalis where the chorionic villi adhere directly to the myometrium with trophoblastic invasion. Accurate antenatal diagnosis is needed to plan for an appropriate delivery strategy at an experienced center in order to reduce maternal and potential fetal morbidity and mortality. Obtaining radiologic and clinical data when PASD is first suspected can play a significant role in formulating an appropriate delivery strategy. Depending on the clinical risk factors and initial imaging findings, transabdominal ultrasound of the pregnant uterus with duplex Doppler and transvaginal ultrasound as needed are the most appropriate imaging procedures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Liina Poder
- University of California San Francisco, San Francisco, California.
| | - Stefanie Weinstein
- Research Author, University of California San Francisco, San Francisco, California
| | | | | | - David C Mackenzie
- Maine Medical Center, Portland, Maine; American College of Emergency Physicians
| | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Brown BP, Meyers ML. Placental magnetic resonance imaging Part II: placenta accreta spectrum. Pediatr Radiol 2020; 50:275-284. [PMID: 31975185 DOI: 10.1007/s00247-019-04521-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/09/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
The human placenta remains an enigma to many. Its position as the point of communication between distinct maternal and fetal circulations means that it must act as both source of nourishment and gatekeeper for the developing pregnancy. In vivo assessment of the placenta is perhaps the greatest challenge, yet it is most essential for diagnostic and prognostic purposes. In particular, there is a need for improved diagnostic accuracy in recognizing the invasive forms of the placenta accreta spectrum that require surgical intervention at delivery and often cesarean hysterectomy. The costs of insufficient sensitivity and specificity are high, with well-documented cases of adverse outcomes ranging from unnecessary surgery to maternal hemorrhage and even death. In Part I of this pictorial essay series, we reviewed the appearance of the normal developing placenta across gestation by MRI. With this as a background, we here consider the varied appearances of the placenta accreta spectrum (placenta accreta, increta, percreta), which is a growing challenge given the rapidly expanding number of women worldwide with history of cesarean section delivery. Accurate prenatal imaging is crucial for recognizing cases of the placenta accreta spectrum and for planning the necessary surgery.
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Affiliation(s)
- Brandon P Brown
- Division of Pediatric Radiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
- The Fetal Center at Riley Children's Health, Indianapolis, IN, USA
| | - Mariana L Meyers
- Pediatric Section, Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO, 80045, USA.
- Colorado Fetal Care Center, Aurora, CO, USA.
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Delli Pizzi A, Tavoletta A, Narciso R, Mastrodicasa D, Trebeschi S, Celentano C, Mastracchio J, Cianci R, Seccia B, Marrone L, Liberati M, Cotroneo AR, Caulo M, Basilico R. Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome. Abdom Radiol (NY) 2019; 44:1873-1882. [PMID: 30600374 DOI: 10.1007/s00261-018-1882-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the diagnostic accuracy of MRI for placenta accreta spectrum (PAS) and clinical outcome prediction in women with placenta previa, using a novel MRI-based predictive model. METHODS Thirty-eight placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. The presence of T2 dark bands, myometrial thinning, abnormal vascularity, uterine bulging, placental heterogeneity, placental protrusion sign, placental recess, and percretism signs was scored using a 5-point scale. Pathology and clinical intrapartum findings were the standard of reference for PAS, while intrapartum/peripartum bleeding and emergency hysterectomy defined the clinical outcome. Receiver-operating characteristic (ROC) analysis and discriminant function analysis were performed to test the predictive power of MRI findings for both PAS and clinical outcome prediction. RESULTS Abnormal vascularity and percretism signs were the two most predictive MRI features of PAS. The area under the curve (AUC) of the predictive function was 0.833 (cutoff 0.39, 67% sensitivity, 100% specificity, p = 0.001). Percretism signs and myometrial thinning were the two most predictive MRI features of poor outcome. AUC of the predictive function was 0.971 (cutoff - 0.55, 100% sensitivity, 77% specificity, p < 0.001). CONCLUSION The diagnostic accuracy of MRI, especially considering the combination of the most predictive MRI findings, is higher when the target of the prediction is the clinical outcome rather than the PAS.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Via Luigi Polacchi 11, 66100, Chieti, Italy.
| | - Alessandra Tavoletta
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Roberta Narciso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA, 94305-5105, USA
| | - Stefano Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Claudio Celentano
- Department of Medicine and Ageing Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Mastracchio
- Department of Obstetrics and Gynaecology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Roberta Cianci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Barbara Seccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Luisa Marrone
- Department of Obstetrics and Gynaecology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Antonio Raffaele Cotroneo
- ITAB Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Via Luigi Polacchi 11, 66100, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Massimo Caulo
- ITAB Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Via Luigi Polacchi 11, 66100, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Atallah D, Moubarak M, Saliba S, Nassar M, Abboud S, Kesrouani A, Ghossain M, Elkassis N. Placental Malformation: Accreta and Beyond. Placenta 2018. [DOI: 10.5772/intechopen.80588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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